First Name *
Last Name *
Email Address *
Phone *
Street address *
Apartment, suite, unit, etc. (optional)
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State * Select an option…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)
ZIP Code *
Country / Region *United States (US)
Select Your Session *Select Session Date and TimeWednesdays, 4/22-7/15- 6:00 PM to 8:00PMThursdays, 4/23-7/16- 6:30 PM to 8:00 PMWednesdays, 7/29-10/21, 6:00 PM to 7:30 PMThursdays, 7/30- 10/22, 6:30 PM to 8:00 PMTuesdays, 9/15- 12/15, 6:00 PM to 7:30 PMTuesdays, 9/15- 12/15, 6:30 PM to 8:00 PMSession Date and Time
Tell Us About You *Briefly tell us about your journey or what you hope to gain from the support group
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I understand that this is a virtual support group and that sessions are confidential. *
I agree to the terms and conditions and privacy policy. *
I acknowledge that the program consists of 13 weekly sessions and I am financially responsible for the full program fee of $325, regardless of attendance, unless otherwise arranged in writing in advance with Defining Tomorrow. *
Apartment, suite, unit, etc. *
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Our support groups are $25 per week or $300 for the full 13-week program when you pay in full.
